Increased factor VIII associated activities in Cushing's syndrome: a probable hypercoagulable state

Area of Science:

• Endocrinology
• Hematology
• Coagulation Science

Background:

• Cushing's syndrome is characterized by elevated cortisol levels.
• Patients with Cushing's syndrome have a higher risk of thromboembolic complications, especially post-surgery.
• The specific hemostatic abnormalities underlying this risk are not fully understood.

Purpose of the Study:

• To investigate the relationship between cortisol levels and coagulation factors in patients with Cushing's syndrome.
• To assess the impact of treatment on cortisol and coagulation parameters.
• To explore the potential role of Factor VIII in the increased thrombotic risk associated with Cushing's syndrome.

Main Methods:

• Investigated 15 patients (13 women, 2 men) with Cushing's syndrome.
• Measured plasma and urinary cortisol, Factor VIII (antigen, activity, von Willebrand factor), and other coagulation assays.
• Collected samples before and serially for 11 months after treatment (surgery, medical, or radiation therapy).

Main Results:

• Pre-treatment cortisol and Factor VIII levels were elevated in patients.
• Following treatment, both cortisol and Factor VIII levels gradually decreased, normalizing within 3-4 months.
• No significant changes were observed in other coagulation tests.
• A positive correlation was suggested between high plasma cortisol and increased Factor VIII production.

Conclusions:

• Elevated plasma cortisol in Cushing's syndrome appears to stimulate Factor VIII production.
• Increased Factor VIII activity may contribute to the thromboembolic complications observed in these patients.
• Monitoring and potentially managing Factor VIII levels could be important for surgical patients with Cushing's syndrome.